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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000645

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Patrick JosephCarnell Sex Male

Date of Birth March 12, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Mary Carnell

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Patrick Carnell Address of Applicant 5159 Morris Street, Halifax Date 29 July 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Patrick JosephCarnell

Born at Halifax in the County of Halifax

That Patrick JosephCarnell Whose Birth is sought to be registered was

born at Halifax Halifax County on March 12, 1922

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Baptism Certificate

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